National Nurses United

M AY | J U N E 2 0 1 6 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 13 W hen pharmaceutical giant Novartis in 2001 introduced Gleevac, a drug viewed as vital for leukemia patients, the annual cost of the treatment regimen was $26,400. That's a whopping price tag, but seems frugal to the astounding rate today: $120,000 a year. "When I saw that price it really hit home," says Martha Kuhl, a pediatric nurse at Chil- dren's Hospital in Oakland, Calif. where leukemias are the most common pediatric cancer and Gleevac is often the treatment. "We see families every day who say they can't afford the co-pays for the medications their children need, or they face becoming homeless or giving up other basic necessities to care for their child. It's heartbreaking, and it's unconscionable." It's not an anomaly. A 2014 Common- wealth Fund survey found nearly 20 percent of adults under 65 did not fill a prescription because they could not afford it. That's why Sen. Bernie Sanders made the drug pricing scandal a fixture on the campaign trail, and has sponsored legisla- tion, S. 2023, to lower drug prices. It's also why an initiative on the California Novem- ber ballot to cut drug prices, Prop. 61, would be an important first step. Pharmaceutical price gouging has become a poster child for the failure of a broken healthcare system that values profits over patient care. Martin Shkreli, sometimes labeled "the most hated man in America," gained notoriety after purchasing Turing Pharmaceuticals and raising the price of Daraprim, used for treating people with compromised immune systems, by 5,500 percent, from $13.50 to $750 a pill. But even after the public reprobation earned him an indictment for conspiracy to commit securities fraud, there remains one inconvenient truth: Shkreli is just the one who got caught. In the past five years, the average price of brand-name drugs has doubled. Between 2008 and 2015, prices of brand-name drugs in the United States exploded by 164 percent. Are these massive, exorbitant charges and increases inevitable? Apparently not. Sovaldi is regarded as virtually a miracle drug, the most effective treatment for people with the liver disease Hepatitis C. One prob- lem. It's maker, Gilead, charges $84,000, or $1,000 per pill, for a 12-week course of treatment. Not everywhere. In Egypt it is reported Gilead sells the same drug, Sovaldi, for just $900 for the same 12-weeks of care. Overall, prices for the world's top 20 sell- ing meds are three times higher in the Unit- ed State than in Britain, six times higher than in Brazil. There's real-life consequences. Those who don't get Sovaldi "can die some of the worse deaths I've ever seen," Laura Bush, a nurse practitioner who works in a commu- nity clinic in a rural New Mexico town, told The Atlantic last September. Predatory pricing can bankrupt states as well as individuals. The Atlantic noted that if state governments were to pay for Sovaldi or similarly priced Harvoni, also made by Gilead, "for all the Hep C patients on their Medicaid and prison rolls, the total bill would have been $55 billion." Exactly why some states are limiting access to the most effective medications. How did we reach this crisis? One answer. From 1998 through the first half of 2016, the pharmaceutical industry spent an aggregate $3.4 billion on federal lobbying— which ranked number one among all sectors in influence peddling. What does that money get? In 2004 Congress approved a President Bush plan to add a prescription drug benefit to Medicare. The plan, however, required the government to pay 106 percent of what the drug kingpins reported was their "average wholesale price" for the Medicare drugs and barred Medicare from negotiating lower prices. When President Obama launched work on what became the Affordable Care Act, the first group invited to the table, as Stephen Brill recounts in his book on the ACA, America's Bitter Pill, was PhRMA, the industry lobbying arm. With the drug companies expected to harvest an additional $200 billion from additional patients mandated to buy private health insurance under the ACA, Obama and Senate staffers asked PhRMA to give some of the money back and fund ads to promote the law. PhRMA succeeded in winning more than just the increased profits: agreement that the administration would press Congress to not reverse the Bush-era ban on allowing Medi - care to negotiate lower prices, and to block efforts to allow consumers to buy drugs cheap- er from Canada, where government bulk purchasing does produce vastly lower prices. Additionally, the Obama administration's proposed Trans-Pacific Partnership, largely crafted by corporate lobbyists, protects monopoly patent protections for the drug giants' brand name medications and threat- ens to "dismantle public health safeguards enshrined in international law and restrict access to price-lowering generic medicines for millions of people," warns Doctors With- out Borders. PhRMA has been similarly successful in buying favors in state capitols where legislation to curb pharmaceutical piracy routinely dies. The drug makers typically justify their pricing practices by claiming they need exor- bitant profits to fund research and develop- ment of new, "innovative" medications. But much of the "research" is simply minor modifications to existing brand name drugs so they can be repackaged with patent protection from generic versions at the same inflated prices, and is based on the dubious standard of "is it better than a placebo?" Two-thirds of new drugs reaching the market fail to provide any therapeutic advance for patients. Further, a substantial percentage of R&D is publicly funded by grants of some $32 billion a year from the National Institutes of Health. Perhaps most telling, the drug giants spend far more on marketing, includ- ing direct consumer advertising as anyone with a TV can surely attest, than they do on research and development. RoseAnn DeMoro Executive Director, National Nurses United Prop. 61 Can Set National Model Time to fight back against Big Pharma (Continued on page 19)

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